Margo Minissian
Cedars Sinai Health System
Is preeclampsia and spontaneous preterm delivery associate with vascular and cardiac function
#Cardiovascular #Women's Health
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There are limited data regarding vascular and cardiac function among women who experience adverse pregnancy outcomes (APO). To date, most studies have presumed similar vascular function amongst APO groups (preeclampsia and preterm delivery), however recent studies suggest major mechanistic and preclinical ASCVD differences amongst the groups. No studies thus far, to our knowledge, have evaluated group differences in mechanistic pathways of APOs, including AIx75, CPP, and PWV.
Executive Summary
Adverse pregnancy outcomes (APOs), specifically, placental disorders including term preeclampsia, spontaneous preterm delivery and preterm preeclampsia have been associated with later development of maternal ASCVD. We postulate that there will be discrete abnormalities in vascular function, cardiac structure and function and lipid biomarker/fibrosis proteomics between each adverse pregnancy group. This new information will provide further insight into mechanisms leading to adverse outcomes and provide opportunities for intervention. In Aim 1, we will investigate group differences (N=120) in vascular function measured by augmentation index and pulse wave velocity at entry (1- 3 months) and at 1-2 years (+/- 3 months) and 2-3 years (+/- 3 months) postpartum. In Aim 2, we will investigate group differences (N=80) in cardiac structure and function measured by CMRI utilizing Cine, Tissue Tagging (left ventricular systolic and diastolic function including strain), T1 mapping (fibrosis), at 1-2 years (+/- 3 months) and 2-3 years (+/- 3 months) postpartum. This. trial will provide real world data to help us further phenotype mechanistic pathways between different APOs including sPTD and women with medically indicated preterm delivery compared to their matched control groups. It will provide important data to drive future R01 applications and ultimately lead to intervention trials. The overarching goal of this study is to improve phenotyping of vascular and myocardial function between each adverse pregnancy group to gain insight into mechanisms leading to adverse outcomes therefore leading to opportunities for intervention trials.
Research Setting
The Principal Investigators are located at Cedars-Sinai Medical Center. CSMC is one of the largest nonprofit academic medical centers in the western United States, with 850 beds and 44 nursing units. For 17 consecutive years, it has been named Los Angeles’ most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities. Biomedical research is an integral component of CSMC mission. Cedars-Sinai Medical Center has been fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP) for assuring protection for our human subjects during research. Cedars-Sinai was the first institution in California to have this designation. AAHRPP is a Washington, D.C. based nonprofit organization that uses a voluntary, peer-driven educational model to accredit institutions engaged in research involving human subjects. Dr. Minissian and the Minissian Research Lab are located on the main campus, North tower, plaza level, suites 2020, 2021, 2033. Licensed space is provided to ensure accessibility to patients for recruitment, testing, and clinical visits conveniently located on the main campus and less than a 5-minute walk to office, clinic and imaging suites. This space is over 4500 sf. and has designated classrooms and workspaces for students. Students have full access to our state-of-the art simulation center which is also located on the Cedars-Sinai campus. Our nursing research department has 4 full-time PhD trained faculty, three of whom are also registered nurses. They provide mentorship to all students perusing graduate level training both clinically and in research.